Episode #161: PCOS & Insulin Resistance: A Step-by-Step Guide

Welcome back to the PCOS Repair Podcast. Today, we’re going to dive a little deeper into PCOS and insulin resistance. First of all, I know this can sound like a broken record—we talk about insulin so much here on the podcast—but it’s one of the key hormones that’s so dependent on lifestyle. And even beyond PCOS, this is a broader societal issue. But when it comes to PCOS, insulin resistance is such a root cause factor for almost everyone. The tricky thing is, it doesn’t have one specific look on the outside. It’s not just people who are overweight, or who eat a certain way. There are so many nuances to insulin resistance and PCOS, and that’s exactly what we’re going to talk about today.

So without further ado, let’s dive in. Insulin resistance is one of the most common causes of PCOS. Even in research, it’s shown that somewhere between 70% and 80% of people with PCOS have insulin resistance. Let’s take a step back and ask: what does it actually mean to have insulin resistance? Insulin is a healthy hormone. It’s something we want our bodies to have—it’s not the enemy—but it can struggle to function properly.

Here’s how it works: when we eat something, it turns into blood sugar in our bloodstream. That blood sugar signals our pancreas to release insulin. Without insulin, our blood sugar can’t be used by the body. So the food we eat becomes blood sugar, but it’s useless unless insulin tells our cells to open up and absorb it. That’s how our muscles, brain, and other parts of the body get energy. Without insulin doing its job, we feel depleted, low energy, and lethargic—similar to how we’d feel with low blood sugar, even though blood sugar is present but not being used properly.

Insulin sensitivity means our cells respond well to insulin. For example, let’s say you eat something, your blood sugar rises, and your pancreas releases insulin. If you’re insulin sensitive, your cells—like your muscle cells—get a little nudge from the insulin and open up to absorb the sugar. That’s a healthy, efficient system. But as we start to become more insulin resistant—and remember, this is a spectrum—it doesn’t happen overnight. It starts gradually. So what insulin resistance looks like is this: your blood sugar rises, insulin is released, but the cells ignore it. The pancreas pumps out more insulin, shouting louder to get the cells to respond. The more insulin it takes to get the job done, the more resistance you’re developing. Eventually, it takes so much insulin that you officially reach insulin resistance. We can test this through insulin and glucose levels. If blood sugar stays elevated, it’s a sign that insulin isn’t doing its job well enough.

Now, as insulin resistance worsens, we move along the spectrum toward diabetes. At the diabetic stage, your pancreas might not be able to produce enough insulin anymore. The cells aren’t listening, and now your pancreas is tired from all the work. That’s when both insulin sensitivity and production are compromised.

So how do we test for insulin resistance? We have a few options. Glucose tests and insulin tests can be done in fasting or non-fasting states. A fasting glucose test, typically done in a doctor’s office, tells us how effective insulin was at clearing sugar from the bloodstream. If fasting glucose is high, it means insulin didn’t do its job. High blood sugar damages our blood vessels, so this matters. We can also test blood sugar with finger pricks, especially after meals. This is more common in people managing diabetes and less often used in early PCOS, but it’s still a helpful tool.

Another option is a fasting insulin test or an insulin challenge test. The latter is similar to what’s done in pregnancy—you drink a sugary solution and your insulin and glucose are measured over time. This helps us see how much insulin is being produced and how well your body is responding. The problem is, if we only test glucose, we can miss insulin resistance until it’s already advanced. For example, blood sugar might look normal, but only because your body is releasing large amounts of insulin to keep it there. We don’t know how hard insulin had to work unless we measure it.

That’s where a continuous glucose monitor (CGM) can be incredibly helpful. CGMs don’t measure insulin, but they show glucose trends throughout the day—after meals, during sleep, and during stress. If you eat something sugary and get a big spike followed by a sharp crash, it likely means your body overproduced insulin. That’s a red flag for early insulin resistance, even if lab tests haven’t caught it yet. Your average blood sugar might be fine, but these swings can tell us a lot.

Most insurances will cover CGMs to some extent. Out of pocket, they may cost $75–$90, but insurance often brings that down to $30–$36. You don’t need to wear one all the time. I usually recommend wearing one for 4–6 weeks—two to three sensors, each lasting two weeks. The first week or two is just observing normal life and how food and routines affect your glucose. The second round can be used to experiment and implement changes.

If you see a spike and crash after eating something like an apple, it means your insulin likely overreacted. Your body overcompensated, removing more sugar than necessary, and now you’ve crashed. This shows that insulin resistance is creeping in, long before lab work might catch it.

This gives us a powerful tool to recognize early patterns. Labs like hemoglobin A1C are averages of blood sugar over three months, which won’t catch swings or early issues. The CGM shows how your body is functioning in real time.

Now, let’s talk about symptoms. Classic insulin-related symptoms include fatigue, sugar cravings, weight gain, and brain fog. You might feel a boost after eating and then crash—that’s a blood sugar rollercoaster. Cravings often follow because your body wants to repeat that sugar high. Insulin also signals the body to store fat, so weight loss becomes more difficult. Irregular cycles are another key symptom—excess insulin triggers more androgens, disrupting ovulation.

So how do we manage insulin resistance in PCOS? Nutrition is the cornerstone—it’s the most talked about and rightly so. But movement is also crucial. Exercise helps your muscles become more insulin sensitive. Active muscles respond better to insulin. If you’re sedentary, your muscles are sluggish and less responsive. Strength training and regular movement improve circulation and insulin sensitivity.

Sleep is another major factor. Poor sleep increases stress hormones like cortisol, which then raises insulin levels. This worsens PCOS symptoms. Certain supplements and medications can also help—inositol, berberine, chromium, and metformin are common options. These work differently for everyone. Some people find them too strong at first, experiencing symptoms like brain fog or feeling weak, especially if their body is used to higher blood sugar levels.

You may need to start with a low dose or take them every other day, ideally under the guidance of your healthcare provider. Using a CGM while starting supplements is a great idea—it helps you understand how your body is responding. You’ll know if your blood sugar is dropping too fast and whether that’s what’s causing your symptoms.

All these supplements—inositol, berberine, chromium, metformin—aim to lower blood sugar. Don’t take them all at once. Introduce one at a time, start with the stronger one, and work with your provider to see what works best for you.

Lastly, tracking your progress is key. That includes tracking your cycle, symptoms, labs, CGM data, and even body composition. All of it gives you a clearer picture.

I hope this episode helped you better understand how insulin works, where it starts to go wrong, and how to recognize the early stages of resistance. Even though we’ve talked about insulin many times, I know it can still be confusing. People often say, “My doctor tested me, and I’m not insulin resistant,” but they don’t realize the limitations of that testing. Even with a CGM, we’re making inferences based on blood sugar behavior—but it’s still a much clearer window into what’s really going on.

If you have follow-up questions, you know where to find me—over on Instagram @nourishhealthy. And if you found this episode helpful, please hit subscribe on your favorite podcast platform so you’ll be notified each week when a new episode is released. Until next time, bye for now.